All issues > Volume 52(2); 2009

Original Article

Korean J Pediatr. 2009;52(2):234-241. Published online February 15, 2009.

Low T3 syndrome in Kawasaki disease: Relation to serum levels of tumor necrosis factor-α, interleukin-6 and NT-proBNP

Hye Kyung HK Cho¹, Jin A JA Sohn¹, Hae Soon HS Kim¹, Sejung SJ Sohn¹

¹Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea

Correspondence Sejung SJ Sohn ,Email: sohn@ewha.ac.kr

Abstract

Purpose
: We investigated the relationship between thyroid hormone and serum tumor necrosis factor (TNF-α), interleukin (IL-6) and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients with Kawasaki disease (KD).
Methods
: Serum levels of thyroid hormone, TNF-α, IL-6, and NT-proBNP were measured in 52 KD patients in the acute and subacute phase and 10 patients with acute febrile illness (control group). TNF-α and IL-6 were determined by sandwich enzyme-linked immunosorbent assay (ELISA). Echocardiography was performed to detect coronary artery lesions (CAL) in KD patients.
Results
: Low T3 syndrome occurred in 63.5% of KD patients. T3 in the acute phase of KD was lower than that in the control. In KD patients, T3 was lowered in the acute phase and elevated in the subacute phase, whereas TNF-α, IL-6 and NT-proBNP were elevated in the acute phase and decreased in the subacute phase. NT-proBNP, and IL-6 were higher in patients with low T3 than in those with normal T3. In addition, T3 inversely correlated with IL-6 and NT-proBNP. Of the 4 patients with CAL, 3 had very low T3. Compared with intravenous immunoglobulin (IVIG)-responsive patients, IVIG-resistant patients had lower T3 and higher IL-6 and NT-proBNP.
Conclusion
: T3 decreases in the acute phase of KD and normalizes in the subacute phase without thyroid hormone replacement. Low T3 may be partially induced by IL-6 rather than TNF-α, and is strongly associated with high NT-proBNP. T3 in KD may be used for the differential diagnosis, monitoring the activity of the disease, and predicting the severity of inflammation.

Keywords :Mucocutaneous lymph node syndrome, Euthyroid sick syndrome, Tumor necrosis factor-α, Interleukin-6, Pro-brain natriuretic peptide